PROFESSOR NICK GOODWIN Director, Central Coast Research Institute for Integrated Care, University of Newcastle and Central Coast LHD. Co-Founder, International Foundation for Integrated Care
Realising the value of integrated care in Australia beyond
Over the past decade there has been a growing realisation of the need to reform health and care systems in Australia to better coordinate care, improve quality and promote value. For example, recent reports such as the 2017 Productivity Commission’s Shifting the Dial and the 2018 CSIRO report Future of Health criticised the existing disease-based, episodic, medicallydominated and institutionally- led characteristics of the Australian health system as being unable to respond effectively to the new challenges of age-related chronic illnesses and the very high percentage of Australians living in ill-health. A more person-centred and integrated approach was required, including a shift in funding away from rewarding volume to incentivising value, empowering consumers, addressing health inequality, unlocking the value of digital health, and building integrated care solutions and new workforce skills. Indeed, almost all States and Territories across Australia—to different degrees of coherence and intensity—have developed policies and programs in this space. Despite progress, the compelling
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The Health Advocate • AUGUST 2020
case for integrated care as central to healthcare reform activities appears missing—or at least is subordinate to other priorities and concerns, many of which largely preserve the status quo (see Goodwin 2019 Taking integrated care forward in Australia: an international perspective, available at: https://integratedcarefoundation.org/wp-content/ uploads/2019/03/2.-Taking-integrated-care-forward_ Commentary_N-Goodwin.pdf). Moreover, where it is politically driven the hardest, ‘integrated care’ has become code for hospital avoidance strategies to reduce costs rather than improving care and outcomes for people in ways that add value. The impact of COVID-19 has thrown into sharp relief the problems that fragmented health and care systems face in adapting to crises that require an urgent and collaborative response. The disproportionate impact of the pandemic on, for example, ethnic minority and Indigenous populations; older people living in residential aged care facilities; those living in rural and remote communities; the poorest; and people with the most complex health and care needs—says much
